Provider Demographics
NPI:1508100934
Name:STANLEY, LAURA EVANS (ARNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:EVANS
Last Name:STANLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 W GRANADA BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8256
Mailing Address - Country:US
Mailing Address - Phone:386-252-8051
Mailing Address - Fax:
Practice Address - Street 1:1265 W GRANADA BLVD STE 3
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8256
Practice Address - Country:US
Practice Address - Phone:386-252-8051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9273799363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health